Health II Unit 203

1. Health IIUnit 203 Position and Move Patients

2. Principles of Proper Body Alignment • good body alignment is essential for the well being of a patient, regardless of whether they are sitting or lying

3. Principles of Proper Body Alignment • when someone is in good alignment, they “look comfortable” • spine should be straight • shoulders/hips/knees parallel to one another and parallel to the sides of bed or chair • no slumping, twisting, bending or unnatural positions

4. Complications Related to Poor Body Alignment • contractures • if position of body is not changed regularly and detailed attention is not given to proper body alignment of the patient, contractures may develop • REMINDER, a contracture is a permanent shortening/tightening of a muscle

5. Complications Related to Poor Body Alignment • pressure areas • areas of pressure are increased when the body is in poor alignment and not changed regularly that may cause pressure ulcers • REMINDER: pressure ulcers begin with a redness of the skin and may continue to large open and deep sores

6. Common Alignment Problems • Neck flexion • may cause strain on the neck muscles • may restrict the act of breathing, leading to shallow breathing or possibly an airway obstruction and death

7. Common Alignment Problems • Shoulder internal rotation • may cause contracture at shoulder and loss of the ability to externally rotate shoulder • Adduction of shoulder • will lead to loss of ability to abduct shoulder

8. Common Alignment Problems • Wrist flexion • may cause wrist drop and weak grasp Wrist drop due to hanging over edge of pillow in flexed position

9. Common Alignment Problems • Lumbar spine convexity • causes low back pain , due to lack of support to the spine direction of spine curvature

10. Common Alignment Problems • Lumbar spine convexity • to reduce the convex curve of the back, the patient’s knees must be flexed to flatten the spine against the bed and gain support or sometimes a small pillow under the “small of the back” may be necessary • h spine flattened & supported by bed

11. Common Alignment Problems • Hip external rotation • causes hip pain, decreased range of motion or contracture of the hip

12. Common Alignment Problems • Knee hyperextension(beyond normal extended position) • causes a painful stretch of nerves & blood vessels in back of knee. This position may lead to loss of normal ROM of the knee flexed knee hyperextended knee with foot on blanket

13. Common Alignment Problems • Ankles • may lead to plantar flexion (“foot drop”) if the ankle is not maintained @ 90 degrees toes pointed forward & down

14. Common Pressure Areas

15. Common Pressure Areas Grsaphic:www.info.gov/hk

16. Common Pressure Areas • Ears/Head • the ears & head may experience pressure from the pillow or bed when the patient is placed in prone, side lying and supine positions • Shoulder/Scapula • shoulder blades will experience pressure from the bed when patient is placed in the supine position

17. Common Pressure Areas • Elbows • the olecranon process of proximal ulna (tip of elbow) will experience pressure when the patient is in supine or prone positions

18. Common Pressure Areas • Sacrum/Coccyx/Hips • the ischial bones that supports the weight of the patient while sitting & the tailbone may feel pressure while sitting or lying • greater trochanter may feel pressure while patient is sitting or sidelying Graphic: www.dinf.ne.jp

19. Common Pressure Areas • Ankle • medial and lateral malleoli when the patient is lying in the side lying position • Heel • while patient is in the supine, or any of the Fowler’s positions • Toes • when lying in the prone position, or heavy bedding over toes when lying supine Graphic: z.about.com

20. Purpose of Supports • provide comfort • reduce stress and strain on joint structures and muscles • reduce risk of pressure ulcers • provide elevation of body parts to reduce edema • support used to reduce effects of immobility and provide patient comfort

21. Types of Supports • pillows

22. Types of Supports • rolled bath blankets • rolled towels • rolled washcloths Bath blanket Washcloth roll Towel roll

23. Types of Supports • splints (upper & lower extremities) • hand cones ankle splint Hand cone bar prevents rotation of lower extremity Wrist & hand splint

24. Criteria for Selecting Supports • will vary • each patient unique • review chart • communicate with patient about areas of discomfort • visually inspect body for support needs

25. Support(s) for Specific Health Conditions • Paralysis • requires support to the affected area(s) • Fractures • will require support(s) to prevent rotation of the fractured part, and elevation of the fractured part to minimize swelling of soft tissue

26. Support(s) for Specific Health Conditions • Diabetic Patients • have diminished circulation that causes decrease of skin’s ability to recover from an injury • diabetics are prone to pressure ulcers and must be monitored carefully • complications from pressure ulcers in a diabetic patient can result in the amputation of a lower extremity

27. Key FactorsSupport Devices • the longer the length of immobility, the more sensitive the skin due to decreased circulation • protect pressure points the thinner the patient the more supports that are needed • too much support may limit movement and have a reverse effect • keep bedding loose • bed linens should be clean dry and wrinkle free

28. Supine Position • lying on back, face up • spine straight & parallel to sides of bed • shoulders, hips, knees aligned with one another • hips extended, legs are apart so that skin is not rubbing against skin of opposite leg • ankle in a 90 degree angle with toes up

29. Consider These Support(s) for Supine Position • pillow of suitable thickness under head and shoulders (avoid hyperextension and hyper-flexion of the neck) • small pillow under lumbar spine to prevent convex curve • blanket rolls (trochanter roll) to prevent external rotation of lower extremities centered at the greater trochanter of each femur

30. Consider These Support(s) for Supine Position • small pillow under thighs for knee flexion • foot splints, foot board, pillows or high top shoes to keep feet in 90 degree position • towel roll just superior to heels to keep heels off bed • pillows under elbows with hands above heart to promote good venous blood return • cone to an affected hand to prevent contractures

31. Prone Position • lying face down on abdomen • spine straight & parallel w/ bed rails • shoulders, hips & knees aligned with one another • arms, position of comfort, elbows flexed • hips extended, legs slightly separated

32. Consider These Support(s) for Prone Position • small pillow under head (avoid lateral neck flexion, select appropriate pillow thickness) • small pillow under abdomen just below diaphragm to prevent: • hyper extension of the lumbar spine • reduce pressure of women’s breast • reduce pressure on genitals of men

33. Consider These Support(s) for Prone Position • allow feet to fall naturally over end of mattress or support lower legs on pillow so toes hang over edge of pillow and not touch bed to prevent pressure ulcers • hand cone in affected hand to prevent contractures Toes over edge of mattress

34. Advantages of Prone Position • promotes drainage from the mouth • only position that allows full extension of the hip and knee that may prevent contractures of these joints

35. Disadvantages of Prone Position • gravity produces lordosis of the spine (exaggerates the sway back) • should not be used with neck/spine problems • inhibits chest expansion so should not be used for patients with cardiac and respiratory disorders

36. Fowler’s Position • head of bed elevated 90 degrees, patient sitting upright • no pillow under head and shoulders • upper torso supported by arms on a pillow placed on an over the bed table • shoulders, hips, knees aligned with one another • spine parallel to the sides of bed

37. Semi-Fowler’s Position • reclining, semi-sitting position • head of the bed elevated 15-45 degrees • lower end of bed elevated to full potential or pillows placed under distal thigh area to cause knee flexion

38. Semi-Fowler’s Position • shoulders, hips and knees aligned with one another • spine parallel to the sides of bed • shoulders and hips in neutral position

39. Consider These Support(s) for Semi-Fowler’s Position • pillow to support head, neck & upper shoulders to prevent flexion of the neck • small pillows under distal femur if b knees to prevent hyperextension of knees

40. Consider These Support(s) for Semi-Fowler’s Position • “trochanter roll” lateral side of femur centered at the greater trochanter to prevent lateral (external) rotation of femur

41. Consider These Support(s) for Semi-Fowler’s Position • towel roll under ankles to lift heels off bed

42. Consider These Support(s) for Semi-Fowler’s Position • foot board, rolled pillows, foot/ankle splints to prevent plantar flexion by keeping ankle in a 90 degree position 90 degree ankle angle w/pillow 90 degree ankle angle w/professional splint

43. Consider These Support(s) for Semi-Fowler’s Position • pillow under each elbow with hand supported above the elbow to promote good venous blood return & prevent pressure ulcers • hand cone or splint in affected hand to prevent contractures • Note: do not let the wrist drop • over the edge of the pillow, • as this may lead to “wrist drop”

44. Side-lying Position • patient lying on side • spine parallel to sides of bed • hips & shoulders aligned w/ themselves & each other • weight of upper torso supported on lateral border of scapula, not directly on shoulder joint • top leg, top arm, head & back supported • Note: the greater the flexion of top hip • & knee, the more stable & balanced • the position

45. Consider These Support(s) for Sidelying Position • the top leg should be supported with a firm pillow first, have it near or on bed when patient is turned • use pillow as a catcher’s mitt, and place knee in center of pillow • this support relieves stress on the back muscles • pillow under head that will not cause lateral flexion of the neck (size of support will vary per individual)

46. Consider These Support(s) for Sidelying Position • pillow under top arm to prevent internal rotation of the shoulder that could lead to limited shoulder movement and may impair chest expansion during breathing. Do not allow wrist to hang over edge of pillow • pillow rolled behind back to prevent patient from falling backwards • pillow or blanket roll to plantar surface of foot to prevent plantar flexion • hand cone in affected hand to prevent contractures

47. SIM’S Position • combination of sidelying & prone posture • bottom arm positioned behind the patient • upper arm flexed at shoulder & elbow near the head • legs flexed, top leg more flexed than bottom

48. SIM’S Position • SIM’S • this position promotes drainage from mouth & prevents aspiration & may be used with the unconscious patient • position may be used when administering rectal medications/enemas or examinations of the perineal area • used for paralyzed patients to reduce pressure over sacrum & greater trochanter • pregnant women often prefer this position for sleeping

49. Consider These Support(s) for SIM’S Position • pillow or folded towel (optional) under head. The wider the patient’s shoulders, the more likely this will be necessary. Avoid lateral flexion of the neck • pillow under top arm to prevent internal rotation of shoulder and arm, reduces pressure on chest • pillow under top knee to prevent internal rotation and adduction of the hip and leg

50. Consider These Support(s) for SIM’S Position • blanket roll or ankle splint to keep ankle in an extended position (90 degree angle) to prevent plantar flexion of the top foot • toes of bottom foot should hang over the edge of the mattress, or washcloth roll placed proximal to the toes under dorsal aspect of foot to lift toes off bed & prevent pressure ulcers • hand cone in affected hand to prevent contractures